ePA 3.0: Why doctors warn against electronic patient files for children
The lifelong electronic patient file is coming automatically for everyone – including children. Doctors see this as a danger and potential for conflict.
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Version 3.0 of the electronic patient record (ePA) is causing debate in Germany. While the Federal Ministry of Health in particular never tires of emphasizing its advantages, there are still many unanswered questions. All people with statutory health insurance, including children, are to receive an electronic patient file by mid-February – unless there is an objection. From the age of 15, young people can object themselves, and parents can object for younger children.
However, doctors and psychotherapists see problems that have not yet been sufficiently resolved. In the past, doctors' representatives had already criticized the fact that children should automatically receive an ePA and that there were legal uncertainties in this regard. The Federal Ministry of Health has not yet commented on the demands.
Pediatricians and adolescent doctors call for opt-in
According to the Berufsverband der Kinder- und Jugendärzte e.V. (BVKJ), one of the unresolved issues concerns the filling of the ePA if the legal guardians express different wishes regarding the storage of their children's data. It is also unclear whether the objection of a parent is sufficient to prevent the ePA from being created. The association finds it problematic that the data of young people under the age of 15 is not protected. The legal guardians could gain access, even if the adolescents express a legitimate interest in not informing their parents, for example when seeking contraceptive advice.
The BVKJ also criticizes (PDF) the fact that doctors are obliged to fill children's ePAs with sensitive data that could lead to stigmatization or discrimination. Even if the doctors are convinced that this is not in the child's best interests. Michael Hubmann, President of the BVKJ, emphasizes that he would advise guardians and patients to carefully weigh up the decision on their participation in the electronic health record until the aforementioned problems have been resolved. He demands that the wish for non-storage, even if it is only expressed by one parent or a child older than 14 years, must be taken into account.
The demands of the BVKJ are also supported by the Association of Statutory Health Insurance Physicians in Bavaria, among others. In the past, the Association of Statutory Health Insurance Physicians of Lower Saxony had also pointed out the potential for conflict in practices. At a meeting of representatives of the National Association of Statutory Health Insurance Physicians (PDF), a resolution was recently passed to change the ePA from an opt-out to an opt-in model for minors. They also demand that billing and diagnostic data can only be viewed by the insured person themselves and made available to other practitioners if required.
Lack of clarity regarding access options
As long as there are still uncertainties, for example with regard to access and viewing options for the electronic patient file, especially for children, those responsible should refrain from opting out for the time being," says Mathias Heinicke, Chairman of the Federal Association of Contract Psychotherapists and an expert on digitization and data protection issues.
According to Heinicke, the potential for conflict that could be passed on to practices is great. It is possible, for example, that a child has family insurance through a non-custodial primary insured person (such as the mother's new partner) who does not have custody, but is still responsible for the child's ePA under the insurance policy. Although these and similar cases are exceptions, they still harbor potential for conflict. The association had therefore already called for an opt-in for children in the electronic patient file at the beginning of 2024.
Insufficient information
The doctors' associations are calling for health insurance companies to provide their policyholders with more comprehensive information about the ePA than they have done to date, as consumer advocates recently advised following the results of an analysis of information letters from health insurance companies. The medical associations Medi Geno Deutschland and Medi Baden-WĂĽrttemberg have also warned of the dangers of inadequate patient information about the risks of ePA. They criticize the fact that some health insurance companies are primarily pursuing their own interests when informing their policyholders. In their letters, many health insurance companies mainly provide information about the advantages of the ePA, while topics such as data protection are not addressed. According to MEDI CEO Dr. Norbert Smetak, this is in line with the feedback from their patients.
"We psychotherapists in particular have to deal with especially sensitive health data. Uninformed patients will not adequately protect their health data either. This means that we have to provide even more information, which is hardly feasible in the current care situation," explains Dr. Christian Messer, Deputy Chairman of MEDI GENO Germany. According to Messer, the duty of confidentiality will also be breached by the ePA: "If the findings are accessible to the pharmacy assistant in future, it will no longer be clear who is liable in the event of a breach of confidentiality".
Danger of the commercialization of health data
MEDI also warns of a possible commercialization of health data. Federal Health Minister Karl Lauterbach confirmed these concerns at Bitkom's Digital Health Conference when he reported on the interest of IT giants such as Meta, OpenAI and Google in German health data. MEDI CEO Dr. Norbert Smetak emphasized that this data is collected exclusively for treatment purposes. A legal clarification of the "right of disposal of pseudonymized health data" is therefore required.
(mack)
